Posted on behalf of Dr Ellis ? please could you reply directly to him:
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Dear ACB List members
We have a patient who visited our breast clinic and had some blood
tests for bilateral breast development.
His ALT was 55 (10-50 U/L) with normal bilirubin, alkaline
phosphatase, and prolactin.
LH & FSH were both suppressed (<1 U/L).
Testosterone (Siemens Centaur) was 165 (10-30 nmol/L)
Oestradiol (Architect ci1200) was 391 (0-160 pmol/L)
He is a body builder and has taken Decca-Durabolin (nandrolone) and
testosterone.
Assuming values are real, with no immunoassay cross-reactivity:
Would you expect that level of oestradiol by aromatisation of that
level of testosterone?
If he had an adrenal (or testicular: normal ultra-sound & HCG) tumour,
if we can persuade him to stop his hormone supplements (and now his
prescribed tamoxifen for his breast enlargement), how long should we
wait to check his hormones again?
While a long delay would be good to get his ?natural? levels, we don?t
want to delay if he does have an adrenal tumour.
Would a month be a good compromise?
Are there any other tests/checks that we should do? (additional to
getting an extraction assay oestradiol or a mass spec oestradiol, if
values are high again). Does anyone have a mass-spec oestradiol method?
Thank you
Graham Ellis
Clinical Biochemistry
St. John?s Hospital
Livingston
West Lothian
EH54 6PP.
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